| NPI | 1164490009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: ME POD1057) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: ME POD 1057) |
| 213E00000X Podiatrist (Licence: ME POD 1057) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: ME POD 1057) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2019-04-26 |